Promoting cancer prevention activities by primary care physicians. Results of a randomized, controlled trial
McPhee, S.J.; Bird, J.A.; Fordham, D.; Rodnick, J.E.; Osborn, E.H.
JAMA 266(4): 538-544
1991
ISSN/ISBN: 0098-7484 PMID: 2061981 Document Number: 372058
Background: Previous interventions to promote performance of cancer prevention activities have largely targeted physicians in university-based practices. Methods: We randomly assigned 40 primary care physicians in community-based practices to either (1) Cancer Prevention Reminders, computer-generated lists of overdue screening tests, and smoking and dietary assessment and counseling, supplemented by cancer education materials; or (2) controls. For each physician, we reviewed a random sample of 60 medical records for data about screening test, assessment, and counseling performance during 12-month preintervention and intervention periods. We calculated performance scores as percentage compliance with American Cancer Society and/or National Cancer Institute recommendations. Multiple regression analyses provided estimates of incremental differences in performance scores between intervention and control groups. Results: Controlling for preintervention performance levels, significant incremental differences in performance scores between intervention and control groups (P < .05) were achieved for nine maneuvers: stool occult-blood test, + 14.5; rectal examination, + 10.5; pelvic examination, + 11.8; Papanicolaou's smear, + 30.7; breast examination, + 8.7; smoking assessment, + 10.2; smoking counseling, + 17.3; dietary assessment, + 12.3; and dietary counseling, + 13.9. Increments for sigmoidoscopy and mammography were not significant. Conclusion: Computerized reminders can significantly increase physicans' performance of cancer prevention activities in community-based practices.